epidural lipomatosis & Moderate degenerative disc space narrowing & desiccation
So I am 27 years old--gained a lot of weight after I had a baby but have lost 55 pounds since last Feb, 36 of which in the last 5 months. I work out 4 times a week. I've had back pain for a while, lately it was really bad so I had an MRI. This is what it said:
L3-4: Mild disc space narrowing and desiccation. No disc protrusion, central
canal or neural foraminal stenosis.
L4-5: Moderate degenerative disc space narrowing and desiccation. Diffuse
bulging present with a focal central disc protrusion and annular tear resulting
in mild distortion of the ventral thecal sac and mild crowding of the traversing
L5 nerve rootlets without frank nerve root compression. Mild facet arthropathy.
No significant neural foraminal compromise. There is mild epidural lipomatosis
without significant canal narrowing..
L5-S1: Mild diffuse disc bulging without focal protrusion. No neural foraminal
compromise. There is prominent epidural lipomatosis ventrally, investing the S1
nerve rootlets and resulting in constriction of the terminal sac with crowding
of the nerve rootlets of the cauda equina at this level.
No significant paraspinal abnormalities identified.
1. L4-L5 diffuse disc bulging and focal central disc protrusion with annular
tear, without significant central canal stenosis or neural foraminal compromise.
2. L5-S1 epidural lipomatosis resulting in some constriction of the terminal
sac and caudal nerve rootlets. The significance of this finding with respect to
the clinical symptoms is uncertain. There is mild disc bulging without focal
3. No evidence of severe spinal canal stenosis at any level.
My doctor was most concerned about the epidural lipomatosis. Does anyone know what this is, how to treat all of this or help me understand my results? I am scheduled to see a neurosurgeon soon but I want a better understanding ASAP. Thanks so much....
Welcome to the board. Epidural lipomatosis is a relatively rare disorder where there is an accumulation of "fat" that is deposited on or outside the lining of the spine. It may press on the spinal cord and nerves. It is yet one more thing that can compress one or more spinal nerves. The usual symptom is back pain.
Treatment for epidural lipomatosis can be either conservative or surgical. According to the NIH, there is not enough statistical information available (due to the rarity of the disorder) to know which treatments yields the best success.
I would like to suggest that you also have a consultation with an orthopedic spine surgeon, in addition to the neurosurgeon. I am familiar with spine specialists in Milwaukee. You have many good choices in the area. You will definitely want to find a fellowship-trained spine specialist for a review of your MRI and a diagnosis. This is an unusual problem. You will want an experienced specialist to work with you.
Please come back and let us know how you are doing.
Thank you for your response. My general doctor referred me to Dr. Heffez with Milwaukee Neurological Institute. However I think it would be a good idea to see and orthopedic spine specialist as well. Feel free to send any names..my appointment is 9 am tomorrow morning so I will be back to let you know how it goes
I got distracted and failed to finish my post. Because this is in the lower area of the spine below where the spinal cord ends, you need to pay particular attention to a couple symptoms. If you should develop bladder or bowel problems, such as incontinence, or if you should develop sudden muscle weakness, such as a foot drop, call your doctor ASAP. If he is not available, go to the ER and tell them you are concerned about "Cauda Equina Syndrome." You might want to look that up online and read through the symptoms just so you are familiar with them.
The nerves that bundle together to form the "cauda equina" spread out to the genital area, the bladder and bowel area and control the sensations and movement to these organs. If a nerve begins to be damaged due to compression, it can be considered a medical emergency, as the damage can be permanent if left in this state too long.
This is a relatively uncommon event, but anyone with lower lumbar nerve compression needs to be aware of the symptoms.
This was a long time ago but thanks again for your response. I have since lost an additional 30 pounds. Also, I have not had any of the bowel/bladder issues. The neurosurgeon blew me off, the second one I was referred to deduced over the phone that I was not worth her time seeing. It is has only gotten worse, I had 2 months of physical therapy to no avail; one physiatrist said that I had to have RFA instead of ESI, since it is "controversial" to do in some one with epidural lipomatosis. A neurosurgeon friend of my mother's told her that was "hogwash" and I needed another opinion..but I don't know where else to go. (She lives in VA, and I am in WI). I feel like I'm getting brushed off and I want to know WHY I am in so much pain and WHAT to do about it! I don't think that's too much to ask! Any suggestions on what to do/ask on my next appointment with the pain mgmt. doctor?
Yeah I gained a lot and had a LOT to lose! I hired a personal trainer and lost 63 pounds with him, the rest was working out and focusing on my diet; simple things like cutting soda and drinking more water. I'm never going to be a size 2 but I just want to be healthy and feel confident again! Also, From what I've researched obesity is a common cause for E.L. so they can't tell me to lose weight and send me on my way.
My pain symptoms vary;lately I've been feeling it in the top of my spine and the muscles around it are sore, but it doesn't seem I have any problems there. The pain is usually in my lower spine, near the top of my buttocks area. Sitting makes it worse; sometimes I have pain in my left leg when driving; there is an almost constant dull ache but other times it will be more of a sharp, shooting pain and yet other times it is a burning sensation. Laying down alleviates this a little bit, but obviously I can't do that very often (I have a pretty active social life, not to mention a 4 year old daughter.) I also have a TENS unit, which gives me some relief for the 2 or 3 HOURS that I wear it at a time; other than that, meds help. I'm on Cymbalta, Skleaxin, Diclofenac, Piroxicam, and as of right now Norco 10's. I was on Percocet and they worked a lot better, but I'm nervous that my doc just thinks I want the pills. Which I do, but just to get by until they can give me a firm fame plan of what to do! I don't want to be addicted to narcotics but they give me relief; am I supposed to say I don't want them? My insurance (TRICARE-we are a military family) only accepts a few providers and it is a pain in the *** to try to get referrals-esp. when the latest won't even see me in person because I don't need surgery. (We are far from a base, hubby is forced to do recruiting for now) There is really no time when I am pain-free; but it is worse the later in the day it gets. I usually take a pain pill at about 4 pm, then another before bed. I'm trying to get as much info and do as much research on my own as I can; I don't want to be totally uninformed and be forced to go along with whatever this physiatrist says. Thanks for listening
I'm just going to ask a couple questions tonight, as I need to go to bed. I'll write more tomorrow...depending on your responses.
1. Did you ever have an epidural spinal injection?
2. Have you had a complete endocrinological exam? Have you been tested for
3. I'm not familiar with your insurance carrier. Do you know if you can see
doctors associated with Aurora Healthcare?
I wanted to mention that I am familiar with the spine clinic that your neurosurgeon is associated with, and I wanted to assure you that there are more user-friendly places to go and much nicer spine specialists. The doctor you saw prefers to do brain surgery and acts like even complex spine surgery is a bore. He has a reputation of being very rude, and has a gigantic ego.